Grove Medical Associates, P.C.: Menu – Patient Engagement

Date:July 30, 2014

Name of Application Organization:Grove Medical Associates, P.C.

Address:250 Hampton Street

Auburn, MA 01501

Submitter Name:Gail Cetto, R.N.

Submitter Title:Office Manager

Submitter’s email address:

Additional Contact’s Name:Sharon Magner

Additional Contact’s Title:Data Manager

Additional Contact email address:

Core or Menu Item:Patient Engagement

Executive Summary

Grove Medical Associates, P.C. (GMA) is not unlike any other practice, experiencing patient engagement difficulties.Typically contacting patients during business hours is a difficult task, often having to leave messages requesting a call us back.We havediscovered allowing the patient a choice in how they prefer to receive their messages from our office has helped to bridge the communication gap.The Patient Centered Medical Home (PCMH) “mindset” has reinforced the need to engage the patient in their own healthcare.Over the last few years, patients are actively participating in their own care.GMA has tried very hard to educate the patients and also figure out what is the best way to communicate with the patient.

  1. Background Knowledge

Grove Medical Associates, P.C., (GMA), is an internal medicine practice serving Worcester County in Massachusetts and is affiliated with the Central Massachusetts Independent Physicians Association (CMIPA). GMA employs four Board Certified Internal Medicine physicians, a Physician’s Assistant, a Certified Nutritionist (one day a week) who is working towards her CDE certification, registered nurses, medical assistants and administrative support staff.

With a diverse patient population of over 6,500 in an urban setting, our office is always busy. Our focus has always been on the patient – what is best for the patient – and we knew an electronic medical health record was needed to track continuous quality improvement. We have been fully operational since 2005, adding a Patient Portal in 2007, which has greatly enhanced our communication with patients and helped them become more engaged in their care.

2. Local problem being addressed and Intended Improvement

Grove Medical Associates, P.C. (GMA) traditionally relied on patients to contact the office directly when in need of assistance or to speak to a Physician Provider during business hours.We have two full time telephone triage operators who answer all calls.Our current telephone system has the ability to place 25 patients on hold.In 2005, we had nine telephone lines which were oftenalways busy.This caused great frustration on both the part of the patients and the telephone triage operators.Coupled with the Physician Providers only responding to messages two times a day (noontime and late afternoon), this caused patients to call back several times,overburdening the already busy telephone lines.

We needed a better way to communicate with our patients, getting them more involved with their healthcare.We wanted to have the ability to allow patients to communicate outside the working business hours.We needed to decrease the stress on the telephones.We also realized we needed to improve our patient communication satisfaction.Patients were very unhappy when our office only offered telephone communication during business hours.

  1. Design and Implementation

With the implementation of the EHR, the ability to create a telephone encounter directly into the specific patient’s chart was established, in addition to sending the telephone encounter to the Physician Provider, who respondswithin one hour.This allows the telephone triage operators to return calls quickly and eliminated the repetitive calls from the patients looking for an answer.

In early 2007, we added a secure web-based Patient Portal, where patients could contact the office for non-emergent requests. Patientsnowhave the ability to review their personal health records and lab results online. We have one staff member whose responsibility is to answer all patient portal messages,distributingthe messages to the appropriate staff/provider member.This task was added to her other duties since it is NOT time consuming.With the EHR, the Physician Providers have the ability to work from home at night and on the weekends. All web-messages are typically responded to within 24 hours,encouraging use of the medium. We have 5,046 (81% of our practice) patients signed up for the Patient Portal and the patients appreciate the ability to send a non-urgent message at all hours.The staff is easily able to communicate all normal lab results, imaging results and scheduled outside appointmentsvia the Patient Portal.The EHR is set up to send appointment reminders, seven days prior, and again two days prior to any appointments at GMA.

Initially, the front desk staff would ask the patient if they would like to sign up for Patient Portal. Unfortunately patients weren’t receptive, quickly adapting, the front desk staff learned instead to ask the patient their e-mail address upon check-in.The patient was then handed an informative brochure describing the attributes of the Patient Portal displayinginformational images.We added a line to our demographic hand-out requesting the patient’s e-mail address.The patients were also informed the Physician Providers were requesting this information in order to communicate more effectively.We also created two very large banners announcing “Patient Portal,” and wore “Ask me about Patient Portal” buttons for a period of time.

  1. How was Health IT Utilized?

In early 2007, we added a secure web-based patient portal, allowing patients to contact the office for non-emergent requests (refill requests, referral requests, appointment requests and non-emergent questions for the staff or Physician Providers). As a result, patients can now review their personal health records and lab results.

GMA has a website ( which was created to help the patient access important information regarding their health.This website includes links to patient education sites (such as “How to Interpret Your Bloodwork”, etc.), patient forms, frequently asked questions, hours of operation and general information about Physician Providers and the practice.It houses the icon for our Patient Portal link.

Now utilizing the new application (app)healow, created by eCW, patients can access their patient portal account securely and manage their family’s healthcare anytime, anywhere on their smart phone, iPad or tablet.

We have added voice and text messaging as a way to communicate with our patients.Upon check-in the patient is routinely asked their preferred method of contact with our office (voice, SMS (text), e-mail or opts out of all practice communication choice).Their selection allows the automated system to contact them utilizing their preferred method.The automated reminder system sends voice, e-mail or text messaging.

The EHR has the ability to send “campaign messages,” sending automated reminders to patients regarding their overdue preventative tests.We have utilizedthe pneumococcal vaccine campaign and the breast cancer screening campaign to date.GMA noted both campaigns generated a high volume of patient engagement.

  1. Value Derived/Outcomes

INCREASED COMMUNICATION

With the addition of the Patient Portal, GMA noticed a tremendous decrease in the number of telephone calls that the office received.The patients were utilizing the Portal for non-urgent requests rather than calling the office.This did lessen the burden on the telephone lines.This created an easier and less stressful way for the patient to contact our office.Utilizing the reporting from the EHR, we have determined the average Patient Portal web messages is 8,164 annually.This can be computed into a savings of additional staff salary for telephone triage.

PATIENT SATISFACTION

We receive numerous Portal web messages commentingon the ease of use of Patient Portal and rapid response time.Patients love having access to the office at any hour of the day or night.An example of a patient emessage states, “I love this patient portal! It is perfect for Night Shift folk like me. And, I don't have to clog up your phone lines with drivel. This is the best idea since the automated attendant system.” See the attached MHQP (Massachusetts Health Quality Partners) 2013 Patient Experience Survey Report in which GMA was able to achieve a score of 97.4/100 in Communication.

INCREASED QUALITY IMPROVEMENT

With the ease of communication between the patient and the staff, we noticed an increase in our quality improvement measures.We attribute this partly to the ability of the patients to communicate 24/7 using the Patient Portal to inform our office of any outside testing (mammograms, pap screening, colonoscopies, vaccines, etc.) a patient mayhave completed.In the past, patients were too frustrated with the phone system to spend the time calling with this important information.The staff and Physician Providers frequently encourage the patients to send an eMessage with this important preventative measure information to keep their records up-to-date.This increased quality improvement has contributed to an increase in the incentive for P4P money.

MARKETING STRATEGY

With the addition of the Patient Portal we were able to market several new opportunities.We were able to announce the addition of a new physician who was accepting new geriatric patients,and patients were able to preregister on our Patient Portal site.

We also announced our new location when we moved to 250 Hampton Street, Auburn, MA 01501. This was instrumental in ensuring patients did not go to our old location.We had very few incidents of patients getting lost.

We are able to utilize the Patient Portal to announce our annual Flu Vaccine Clinic.Patients are able to emessage us for their appointment.This has made Flu Season much more manageable for everyone involved, including the patient.The patients now wait to be notified via Patient Portal and look forward to it, rather than calling our office.

  1. LESSONS LEARNED

We learned when introducing the Patient Portal, to inform the patients it is the easiest method of communication. Being able to say that your specific physician has asked you to sign up for Patient Portal carries a lot more weight than just asking “Do you want to sign up for the Patient Portal?”Make sure to include a visual aid to help the patient better understand how it looks and how it works.This helps educate the patient and makes them feel more comfortable with the idea.

We learned quickly to be mindful of the number of patients toinclude in a “web blast”.The first flu clinic we announced, we sent a web blast to over 7,000 patients at once, not realizing it would generate several hundred telephone calls and portal messages.It is much easier to break the list into a manageable numberof patients over the course of several web blasts.It is helpful to assign a dedicated staff member to oversee the scheduling of all patient appointments for the flu clinic.

Similar to the web blast scenario,one lesson learned about the eMessage Campaigns was to be mindful of the number of patients a message will be sent to.Ensure the number of patients receiving the message is manageable, asthese eMessage Campaigns generate a considerable number of patient inquiries via phone and Patient Portal.The patient engagement was much higher than anticipated, and we had to inform and educate all staff on how to handle the inquiries.

While establishing preventative measure campaigns, be mindful to reach only the demographic population targeted.We launched the Breast Cancer screening and a corresponding messagecampaign to schedule mammogram appointments. Unfortunately, the message was sent to a patient who did not have a mammogram due to having a bilateral mastectomy.She did not need a mammogram, but at the time our EHR did not know due to the lack of a CPT code in the patient’s chart.We immediately contacted the patient to render an apology for being insensitive.Fortunately, she was so happywe were reaching out to our patientsfor the annual mammograms, thus she was not insulted by this message.We immediately generated a report and made sure to add the CPT code to all appropriate patient charts.

Another lesson learned was to always ask the patient if we can send a text message to them.This is now routinely done at the front desk since a few patients complained any text messages received cost money.

Be aware of any costs involved versus the benefit of the service involved.Each emessage campaign does generate a cost.This cost can be calculated before you run the campaign to decide whether it is cost effective.Each message sent is $0.10 - $0.15 (ten - fifteen cents).It is too early for us to tell if we have reaped any benefit from this.

  1. Financial Considerations

GMA did pay for the design of our Website ( The cost was approximately $2,000.00.The designer showeda staff member how to maintain it and add educational material.The benefits of keeping the patients engaged and educated far outweighed the cost of the website.

There is a $0.10 - $0.15 (ten - fifteen cents) charge for each SMS and/or voice message sent to each patient.We routinely perform daily appointment reminders. Utilizing the SMS/voice emessage versus utilizing staff time calling or mailing each appointment reminder is a less expensive alternative.In 2013, we determined 13,117 patient appointments cost $1,311.70 to send an appointment reminder emessage.If we called these patients with staff members it would cost approximately $3,285.00.

The Patient Portal does not cost anything and is a part of the EHR.The patient portal messages do not generate any additional cost to the patient or the providers.In 2013, we generated 14, 815 patient portal web messages at no cost to the patient or the provider.Translated into the cost of having to make phone calls this would amount to approximately $11,115.00 in staff costs.

Due to the increased patient engagement with utilizing the communication method of choice, we feel strongly that we have improved our quality measures.This does help us with earning additional incentive money from insurers and our local IPA.

MHQP (Massachusetts Health Quality Partners) 2013 PATIENT EXPERIENCE SURVEY REPORT – Communication Score = 97.4

Example of Patient Demographic screen with the option for receiving messages from GMA

Provider Last Name / Provider First name / Campaign name / Month of Delivery / Number of Unique Patient(s) contacted using a single modality / Number of Unique Patient(s) contacted using multiple modalities
John / Kelly / breastcancerreminder / Mar-14 / 0 / 2
David / Weinstock / breastcancerreminder / Mar-14 / 5 / 2
Dennis / Murphy / breastcancerreminder / Mar-14 / 1 / 3
John / Kelly / breastcancerreminder / Apr-14 / 1 / 2
David / Weinstock / breastcancerreminder / Apr-14 / 12 / 0
Dennis / Murphy / breastcancerreminder / Apr-14 / 0 / 1
John / Kelly / breastcancerreminder / May-14 / 0 / 1
David / Weinstock / breastcancerreminder / May-14 / 17 / 0
Dennis / Murphy / breastcancerreminder / May-14 / 0 / 2
David / Weinstock / breastcancerreminder / Jun-14 / 10 / 1
Jarrod / Faucher / breastcancerreminder / Jun-14 / 1 / 0
John / Kelly / breastcancerreminder / Jul-14 / 1 / 1
David / Weinstock / breastcancerreminder / Jul-14 / 8 / 2
Dennis / Murphy / breastcancerreminder / Jul-14 / 1 / 1
John / Kelly / pneumococcalshotreminder / May-14 / 35 / 190
David / Weinstock / pneumococcalshotreminder / May-14 / 14 / 46
Dennis / Murphy / pneumococcalshotreminder / May-14 / 14 / 87
Jarrod / Faucher / pneumococcalshotreminder / May-14 / 2 / 3
John / Kelly / pneumococcalshotreminder / Jun-14 / 3 / 20
David / Weinstock / pneumococcalshotreminder / Jun-14 / 121 / 55
Dennis / Murphy / pneumococcalshotreminder / Jun-14 / 2 / 4
Jarrod / Faucher / pneumococcalshotreminder / Jun-14 / 2 / 42
TOTAL MESSAGES: 721 / 250 / 465

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